Download What If? - Care and Compliance Group

DEMENTIA CARE:
AVOIDING OVERUSE OF
MEDICATIONS
Medications in Dementia Care
2
WHY WORRY ABOUT OVERUSE?
•
Resident rights
•
“Chemical restraints”
•
Side effects and adverse reactions
•
Quality of life
•
Increased fall risk
•
Increased risk of mortality (off-label antipsychotics
3
THREE “CATEGORIES” OF MEDICATIONS
Treat the
disease
Aricept
Namenda
Etc…
Manage
symptoms
Common
medications
Psychotropic
medications
Heart medications
Antidepressants
Anticonvulsants
Etc…
Pain medications
Insulin
Etc…
4
MEDICATIONS FOR MEMORY LOSS
•
FDA has approved two types of medications to
treat cognitive symptoms
•
Cholinesterase inhibitors (Aricept, Exelon,
Razadyne)
•
Memantine (Namenda)
•
Cannot stop damage to brain cells
•
May help lessen or stabilize symptoms
Source: www.alz.org
5
CHOLINESTERASE INHIBITORS
•
Early to moderate stages
•
Prevent the breakdown of acetylcholine, a
neurotransmitter important for learning and
memory
•
Delay worsening of symptoms for 6-12 months
•
Generally well tolerated
6
MEMANTINE (NAMENDA)
•
Moderate to severe stages
•
Improves memory, attention, reasoning, language,
and the ability to perform simple tasks
•
Often used in combination with other drugs
•
Can cause side effects (headache, constipation,
confusion, and dizziness)
7
Psychotropic Medications
8
DIFFERENT NAMES…
•
Psychoactive drugs
•
Psychotropic drugs
•
Psychiatric drugs
•
Psychotherapeutic drugs
•
Psychopharmaceutical
9
PSYCHOTROPIC MEDICATIONS
•
Chemical substances that changes brain function
and results in alterations in perception, mood, or
consciousness
•
Includes prescription drugs to treat mental illness
and recreational drugs
•
Alter neurotransmitters in the brain
10
11
CLASSES OF PSYCHOTROPIC DRUGS
Class
Use
Antidepressants
Major depression, anxiety, eating disorders
Antipsychotics
Psychosis, schizophrenia, mania
Anxiolytics (antianxiety)
Anxiety disorders
Mood stabilizers
Bipolar depression
Stimulants
ADHD
Depressants
Sedatives, anesthesia
12
USE OF PSYCHOTROPICS
•
Use has grown in the last two decades
•
Used for treatment in 77% of mental health cases
•
$2.8 billion in 1987 to $18 billion in 2001
13
WHY HAS USE GROWN?
•
Gains in efficacy and effectiveness
•
Expanding insurance coverage
•
Direct to consumer advertising
•
Convenience of staff
14
ANTIPSYCHOTICS
Conventional
Antipsychotics
•
Chlorpromazine
(Thorazine)
Atypical Antipsychotics
•
Risperidone (Risperdal)
•
Olanzapine (Zyprexa)
•
Quetiapine (Seroquel)
•
Haloperidol (Haldol)
•
Ziprasidone (Geodon)
•
Perphenazine
•
Aripiprazole (Abilify)
•
Fluphenazine
•
Paliperidone (Invega)
•
Lurasidone (Latuda)
15
ANTIPSYCHOTIC SIDE EFFECTS
•
Drowsiness
•
Dizziness when changing positions
•
Blurred vision
•
Rapid heartbeat
•
Sensitivity to the sun
•
Skin rashes
•
Menstrual problems for women
•
Weight gain (atypicals)
16
ANTIPSYCHOTIC SIDE EFFECTS
Traditional antipsychotics:
•
Rigidity
•
Persistent muscle spasms
•
Tremors
•
Restlessness
•
Tardive dyskinesia
17
ANTIDEPRESSANTS
•
Fluoxetine (Prozac)
•
Citalopram (Celexa)
•
Sertraline (Zoloft)
•
Paroxetine (Paxil)
•
Escitalopram (Lexapro)
•
Venlafaxine (Effexor)
•
Duloxetine (Cymbalta)
•
Bupropion (Wellbutrin)
18
ANTIDEPRESSANT SIDE EFFECTS
SSRIs and SNRIs
•
Headache
•
Nausea (feeling sick to your stomach)
•
Sleeplessness or drowsiness
•
Agitation (feeling jittery)
•
Sexual problems
19
ANTIDEPRESSANT SIDE EFFECTS
Tricyclic Antidepressants
•
Dry mouth
•
Constipation
•
Bladder problems
•
Sexual problems
•
Blurred vision
•
Drowsiness
20
MOOD STABILIZERS
•
Lithium
•
Divalproex sodium (Depakote)
•
Carbamazepine (Tegretol)
•
Lamotigine (Lamictal)
•
Oxcarbazepine (Trileptal)
MOOD STABILIZER SIDE EFFECTS
Lithium
•
Loss of coordination
•
Excessive thirst
•
Frequent urination
•
Blackouts
•
Seizures
•
Slurred speech
•
Fast, slow, irregular, or pounding heartbeat
•
Hallucinations (seeing things or hearing voices that do not exist)
•
Changes in vision
•
Itching, rash
•
Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
MOOD STABILIZER SIDE EFFECTS
Depakote
•
Changes in weight
•
Nausea
•
Stomach pain
•
Vomiting
•
Anorexia
•
Loss of appetite
ANTIANXIETY DRUGS
•
Clonazepam (Klonopin)
•
Lorazepam (Ativan)
•
Alprazolam (Xanax)
•
Buspirone (Buspar)
ANTIANXIETY DRUG SIDE EFFECTS
Benzodiazepines
•
Drowsiness and dizziness
•
Upset stomach
•
Blurred vision
•
Headache
•
Confusion
•
Grogginess
•
Nightmares
ANTIANXIETY DRUG SIDE EFFECTS
Buspar
•
Dizziness
•
Headaches
•
Nausea
•
Nervousness
•
Lightheadedness
•
Excitement
•
Trouble sleeping
Reducing the Use of
Psychotropic Medications
27
ANTIPSYCHOTICS AND DEMENTIA
•
May help for people with dementia who have
psychosis
•
Most of the time mis-used for challenging or
disturbing behaviors
•
Don’t address root cause of the behavioral issue
BLACK BOX WARNING
Warning: Increased Mortality in Elderly Patients with
Dementia-Related Psychosis. Elderly patients with
dementia-related psychosis treated with
antipsychotic drugs are at an increased risk of death.
[Name of Antipsychotic] is not approved for the
treatment of patients with dementia related
psychosis
REDUCING OFF-LABEL USE OF ANTIPSYCHOTICS
NCAL QUALITY INITIATIVE
•
Safely reduce off-label use
of antipsychotics by 15%
•
Communities that have
less than 5 percent of
off-label use maintain rates at or below 5 percent
•
All communities will implement use of at least one
tool aimed at reducing off-label use of
antipsychotics
•
www.ncal.org
QUALITY OUTCOMES
•
Improves performance in this quality measure and
potentially affects other measures.
•
Decreases the side effects and adverse drug
reactions associated with these medications.
Source: National Center for Assisted Living, www.ncal.org
FINANCIAL STABILITY
•
Adverse Drug Events (ADEs) may require
hospitalization and the community may experience
lost revenue for days the resident is not in the
community.
•
Trial attorneys may use the incidence of off-label
antipsychotic usage to bolster their cases.
Source: National Center for Assisted Living, www.ncal.org
BUSINESS OPPORTUNITIES
•
A reputation for using innovative, person-centered
care approaches will provide a competitive
advantage.
•
Raises the energy level and fosters a vibrant
atmosphere which is attractive to visitors and
potential customers touring the community.
•
Attracts more innovative practitioners that will
expand a community’s reputation.
Source: National Center for Assisted Living, www.ncal.org
STAFF STABILITY
•
Staff will experience the fulfillment and positive
changes that come when they are focused on
providing care that meets a person’s needs.
•
When staff are more fulfilled, they are engaged.
•
Engaged staff are more likely to recommend their
assisted living community as a place to work. Word
spreads; good care recruits good caregivers.
Source: National Center for Assisted Living, www.ncal.org
CUSTOMER SATISFACTION
•
Non-pharmacologic interventions help to enhance
an individual’s ability to direct their care, which
improves their independence, dignity, and quality of
life.
•
Family members of individuals that are more
satisfied and engaged are more likely to
recommend their facility to others as a place for
quality care.
Source: National Center for Assisted Living, www.ncal.org
TRACKING PROGRESS: INCIDENCE
# of residents with antipsychotic drug use indicated
on medical records over the first 90 days at the
assisted living
# of residents who have been at assisted living for
90 or less days
TRACKING PROGRESS: PREVALENCE
# of residents (who have been at the AL over 90
days) with antipsychotic drug use indicated on
medical records at the end of the target period
# of residents (who have been at the AL over 90
days) at the end of the target period
Non-Drug Care Strategies
39
BEHAVIOR MANAGEMENT
•
Can be one of the most challenging aspects of
caring for residents with dementia
•
The key is to have an established management
technique
•
Behaviors are not resolved, they are managed.
•
Caregivers will find caring for residents with
dementia less stressful if they accept that difficult,
and even bizarre behaviors are a normal part of the
illness
40
THREE KEY POINTS
•
Stop Judging and Become Curious
•
It’s a Need not a Behavior
•
Understand the disease
DEMENTIA IS A DISEASE
IT’S A NEED NOT A BEHAVIOR
•
Discomfort
•
Pain
•
Hunger
•
Frustration
•
Delusions/hallucinations
•
Sad/depressed
OUR APPROACH
• Caregiver actions that startle, threaten, cause pain, or just
annoy the resident
• Not gaining permission
• Not using the Positive Physical Approach
• Not being gentle and calm
• Not respecting the resident’s wishes
• Asking the resident why he/she did something
• Scolding or other “tone-ing”
• Demanding that the resident be polite
• Not using necessary prompts
POSITIVE APPROACH
•
Approach from the front
•
Go slow
•
Get to the side
•
Get low
•
Offer your hand (use preferred name)
•
Skill Builder: Return demonstration of Positive
Physical Approach
TOP 5 TIPS…
1.
Try not to take behaviors personally
2.
Remain patient and calm
3.
Explore pain as a trigger
4.
Don't argue or try to convince
5.
Accept behaviors as a reality of the disease and
try to work through it
•
Source: Alzheimer’s Association
46
BEHAVIOR MANAGEMENT
•
Step 1: Is the behavior a problem?
•
Step 2: What is the problem?
•
Step 3: Who, when and where?
•
Step 4: Why?
•
Step 5: How will you manage the behavior?
•
Step 6: Reassessment
47
STEP 1: IS THE BEHAVIOR A PROBLEM?
•
A behavior is not a problem unless it negatively
affects the resident with the behavior or other
residents
•
If a behavior does not negatively affect the resident
or other residents, management of the behavior is
not necessary
48
STEP 2: WHAT IS THE PROBLEM?
•
Specifically identify what the problem behavior is
49
STEP 3: WHO, WHEN, AND WHERE?
•
Identify with whom the problem behavior occurs,
when it occurs, and where it occurs
•
This can identify specific triggers that may be
causing the problem behaviors
•
Such as specific times of day, specific residents or
staff, or specific places or situations
50
STEP 4: WHY?
•
This step can be difficult but attempt to identify why
the problem behavior occurs
•
If a specific reason for the behavior cannot be
identified, it can be related to a symptom of
dementia
51
STEP 5: HOW WILL YOU MANAGE THE BEHAVIOR?
•
This step must be done as a team effort
•
All members of the staff and caregivers in your
community can contribute
•
Remember, problem behaviors in dementia are
managed, not resolved
52
STEP 6: REASSESSMENT
•
It is vital that the problem behavior is regularly
reassessed
•
Is it getting better?
•
Has it become worse?
•
Should your management solution be changed or
updated?
•
Establish a regular time frame for reassessments,
such as; every day, every week, etc.
53
COMMON TRIGGERS
•
Pain
•
Frustration
•
Demoralizing or infantilizing
approach
•
Misunderstanding a request
•
Fatigue
•
Communication barriers
•
Inability to perform a task
•
Inability to express needs
•
Rapid change in the environment
54
Behavior Tips…
55
AGGRESSION AND ANGER
•
•
•
•
•
•
•
•
•
Try to identify the immediate
cause
Rule out pain as a source of
stress
Focus on feelings, not the facts
Don't get upset
Limit distractions
Try a relaxing activity
Shift the focus to another activity
Decrease level of danger
Avoid using restraint or force
•
Source: Alzheimer’s Association
56
SLEEP ISSUES AND SUNDOWNING
•
Keep the home well lit in
the evening
•
Make a comfortable and
safe sleep environment
•
Maintain a schedule
•
Avoid stimulants and big
dinners
•
Plan more active days
•
Try to identify triggers
•
Source: Alzheimer’s Association
57
SEXUAL BEHAVIOR CHALLENGES
•
Ensure safety of residents and staff
•
Resident rights
•
Ability to consent
•
Communicate with family
•
Relocate if needed
58
THERE IS A DIFFERENCE
•
Wandering vs Elopement
•
Wandering can be safe, but must be monitored
•
Exit-seeking
NY AHSA ELOPEMENT RISK SCALE
•
www.nccdp.org
•
Upon move-in
•
After 72 hours of admission
•
Every month for those identified as high risk to
wander
•
Whenever there is a change in condition
•
0 – 8 = Low Risk
•
9 – 10 = At Risk to Wander
•
11 – above = High Risk to Wander
TIPS FROM WWW.ALZ.ORG
•
•
•
•
•
•
•
•
•
Carry out daily activities.
Identify the most likely times of day that wandering may
occur.
Reassure the person if he or she feels lost, abandoned or
disoriented.
Ensure all basic needs are met.
Place locks out of the line of sight.
Camouflage doors and door knobs.
Alarm doors and windows.
Keep car keys out of sight.
Supervise and monitor!
HOW CCG HELPS
California Southland Chapter has teamed up with Care and
Compliance Group to offer nine online training courses
specific to Alzheimer’s and dementia care:
•
•
•
•
•
•
•
•
•
Over View of Dementia and Alzheimer’s Disease
Communication
Actives
Working with Families
Managing Difficult Behaviors
Personal Care & Special Needs
Elder Abuse and Reporting Laws
Medications for Behavioral Problems in Dementia
The Best Friends Approach to Alzheimer’s Care
63
Sexual Behavioral Challenges
SEX AND DEMENTIA
•
The onset of dementia doesn’t necessarily mean
the end of sexual relationships
•
Intimate relationships may take on a different form
WHAT IS SEXUALITY?
•
The expression of male
and female sexual
desires, instincts and
activities
•
Natural, normal part of
life
•
Even as we age
THE BRAIN IS IN CONTROL
•
Sexual expression may change for residents with
dementia due to changes in the brain
•
Sexual feelings and inhibitions are personal and
individual
•
Sexual feeling can change unpredictably
YOUR RESIDENT MAY EXPERIENCE
•
Greater interest in sex
•
Less or no interest in sex
•
A greater or less ability to perform sexually
YOU MAY SEE
•
Flirting.
•
Seeking attention from someone of interest.
•
Seeking situating oneself close to another.
•
Closer attention to personal appearance.
•
Dressing more suggestive.
•
Enjoying the social company of the opposite sex.
•
Snuggling.
•
Hand holding.
•
Resting head on another’s shoulder
YOU MAY SEE
•
Masturbation in public.
•
Sexual lewd remarks.
•
Initiating uninvited physical contact.
•
Preying on another.
•
Intimidation of another (threatening a consequence
to someone if they do not agree to go along).
•
Forcing intercourse or other sexual act upon
another.
DATA
•
Not all resident residents have challenging sexual
behaviors.
•
In one study of hyper-sexuality among an
Alzheimer’s population: between 2 and 17%.
•
Interestingly, frequency of disinhibited behaviors
had similar frequency between men and women:
•
Males - 8%
•
Females - 7%
THE REAL PROBLEM WITH SEX IN AL
•
The resident’s
family!
POSSIBLE CAUSES/TRIGGERS
•
Need for toilet.
•
Physical discomfort such as being itchy etc.
•
Need for energy release (try dancing or walking).
•
Boredom.
•
Agitation.
•
Becoming overwhelmed.
•
Misunderstanding another’s approach (e.g. caregiver
providing personal care).
•
Mistaking someone for someone else (e.g. spouse or
partner).
GENERAL TIPS
•
Know the whereabouts of each of your residents in
Memory Care.
•
Ensure routine monitoring and checks.
•
Stay in tune to their company and visitors.
•
Keep residents engaged in socially active
programming.
•
Ensure tactile stimulation in activity programs.
•
Provide warm, kind, respectful compliments .
•
Encourage engagement with activities throughout the
day.
GENERAL TIPS
•
Rearrange a person’s day to ensure they are busy
during high stress times.
•
Visit and spend quiet time with resident.
•
Ensure nutrition and exercise routinely.
•
Build residents self esteem with letting them do
what they can do for themselves successfully.
•
Consider personal approaches for different
residents. (Person Centered Care).
WHAT IF?
Resident makes lewd comments while providing
care?
•
Using humor is sometimes effective while redirecting
the conversation.
•
Consider using another caregiver of another gender.
•
Bring music if enjoyed by resident and lead in song.
•
Utilizing “2 person assist” may eliminate comments.
•
Notify supervisor.
WHAT IF?
Resident reaches out and grabs staff in sexual
manner?
•
Stop care, respectfully but firmly say “no or stop.”
•
Change subject immediately.
•
Position self away from resident as safety permits.
•
Change care staff who can manage or does not
experience the same.
•
“2 person assist” may eliminate behavior.
•
Notify supervisor.
WHAT IF?
Resident is engaged in masturbation in public
area.
•
Maintain respect. Remember that resident may not
have ability to understand.
•
Do not reprimand or create attention.
•
Cover if possible and remove resident from area.
•
Assist with any hygiene issue.
•
Attempt to engage resident in activity program.
•
Report to supervisor immediately.
WHAT IF?
Resident is observed masturbating in room?
•
Ensure resident is safe and private.
•
Approach later to assist with hygiene as necessary.
•
Report observation to supervisors.
•
Avoid any unnecessary gossip.
WHAT IF?
Resident propositions another dementia resident?
• Immediately intervene, redirect conversation and engage
residents in separate activities in separate areas.
• Assure resident propositioned 1-1 care for time needed to
ensure resident is emotionally comfortable and feels safe.
• Do not leave propositioning resident alone. Monitor until
behavior subsides.
• Offer snack and/or something repetitive to do with their
hands, wiping, sanding, painting, sweeping, dusting, etc.
• Consider taking propositioning resident for a walk to change
environment.
•
Alert supervisor immediately.
“CAPACITY”
Residents are capable of forming new relationships.
•
Residents may/may not be aware of results, limits,
recognize or understand conditions of relationships.
•
Residents may not recognize safety or health
concerns.
•
Residents may no longer have ability to refuse or
rebuke advances.
•
The term mental “capacity” is difficult to discern and
involves a host of considerations, evaluations,
medically and legally.
“CAPACITY”
Generally speaking, residents who may be considered
able to provide “consent” have a level of awareness for:
• Ability to understand information that is presented.
• Ability to retain information long enough to be able to make
a decision.
• Ability to contemplate information to make an informed
decision.
• Ability to communicate decision by some means.
• Awareness of the relationship.
• Ability to avoid exploitation.
• Aware of potential risks.
Other Common High Risk
Medications
ADVERSE DRUG EVENTS
•
Result in more than 770,000 injuries and deaths
each year
•
Estimated 106,000 fatal ADEs occur annually
•
Cost up to $5.6 million per hospital
•
Side effects
•
Drug/drug interactions
•
Drug/food interactions
ADVERSE DRUG EVENTS
•
Older adults are more susceptible
•
Physiologic changes of aging (circulation, kidney
function, liver function, etc.)
•
Volume of medications (6-9 medications on
average)
•
More likely to be seen by multiple
physicians/providers
BEERS CRITERIA
•
Originally conceived in 1991 by the late Mark
Beers, MD
•
Catalogues medications that cause adverse drug
events in older adults due to pharmacologic
properties and physiologic changes of aging
•
Updated by the AGS in 2012
•
Should be used as a guide
HIGH RISK MEDICATIONS
•
1/3 of emergency department visits by older adults
presenting with ADEs are caused by three drugs
•
Warfarin, insulin, and digoxin
WARFARIN
•
“Blood thinner”
•
Decreases the clotting
(coagulating) ability of the
blood
•
Does not actually thin the
blood
•
Does NOT dissolve existing
blood clots
WARFARIN
•
Used to treat certain blood vessel, heart and lung
conditions
•
Help to prevent formation of harmful clots
•
May prevent the clots from becoming larger and
causing more serious problems
•
Often prescribed to prevent stroke
WARFARIN
SIDE EFFECTS:
•
Bleeding
•
Chest pain
•
Shortness of breath
•
Skin reactions
•
Headache
•
Stomach pain
WARFARIN AND DIET
•
Vitamin K can reduce effectiveness
•
Kale
•
Spinach
•
Brussels sprouts
•
Parsley
•
Collard greens
•
Mustard greens
•
Chard
•
Green tea
WARFARIN AND DIET
•
Cranberry juice
•
Alcohol
•
Can increase the effect of warfarin
INSULIN
•
Discovered in 1921
•
First major breakthrough in diabetes
treatment
•
Prior to this time anyone with
type 1 diabetes died within
a few years after
diagnosis
•
Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
INSULIN
•
Required for type 1
•
Sometimes used for type 2
•
Must be taken regularly
•
Sometimes used in
combination with oral
medications
•
Over 20 different forms
•
Administered via syringe,
pen, or pump
INSULIN PEN
CHARACTERISTICS OF INSULIN
1.
Onset
The length of time before insulin
reaches the bloodstream and
begins lowering blood glucose
2.
Peak
The time during which insulin is at
maximum strength
3.
Duration
How long insulin continues to lower
blood glucose
•
Source: American Diabetes Association, www.diabetes.org
TYPES OF INSULIN
Type
Onset
Peak
Duration
Examples
Rapid-acting
15 minutes
1 hour
after injection
2-4 hours
insulin glulisine (Apidra)
insulin lispro (Humalog)
insulin aspart (NovoLog)
Regular or
Short-Acting
30 minutes
2-3 hours
3-6 hours
Humulin R
Novolin R
Intermediateacting
2-4 hours
4-12
hours
12-18
hours
NPH (Humulin N,
Novolin N)
Long-acting
Reaches bloodstream several hours
after injection and lowers glucose
evenly over a 24-hour period
•
insulin detemir (Levemir)
insulin glargine (Lantus)
Source: American Diabetes Association, www.diabetes.org
INSULIN SCHEDULES
The following will affect blood glucose levels:
•
Eating
•
Exercise
•
Where insulin is injected
•
When insulin is injected
•
Stress
•
Illness
•
Source: American Diabetes Association, www.diabetes.org
SYRINGE SAFETY
•
Dispose of in a sharps container
•
Handle syringes as little as
possible
•
Do not recap needles
•
Safety devices
•
Insulin pens and other
medication cartridges and
syringes should never be
used for more than one person
HYPOGLYCEMIA
•
Low blood sugar
•
Can happen suddenly
•
Side effect of diabetes treatment
•
Can also be a result of other medications,
diseases, etc.
•
Usually mild and can be treated quickly
•
Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
HYPOGLYCEMIA
Symptoms
•
hunger
•
confusion
•
shakiness
•
difficulty speaking
•
nervousness
•
anxiety
•
sweating
•
weakness
•
dizziness or lightheadedness
•
sleepiness
•
Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
HYPOGLYCEMIA
Urgent Treatment
•
Check blood glucose level (if applicable)
•
If the level is below 70 mg/dL, consume one of these quick fix
foods right away:
• 3 or 4 glucose tablets
• 1 serving of glucose gel
• 1/2 cup of any fruit juice
• 1/2 cup of a regular—not diet—soft drink
• 1 cup of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey
•
Recheck blood glucose in 15 minutes (if applicable)
•
Seek medical attention for severe hypotension
•
Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
HYPOGLYCEMIA
Prevention
•
Diabetes medications
•
Meal plan
•
Daily Activity
•
Alcohol consumption
•
Diabetes management plan
•
Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
HYPERGLYCEMIA
High blood sugar that can be caused by:
•
Not taking medication/insulin correctly
•
Eating more than planned
•
Exercising less than planned
•
Stress
•
Illness
•
The “dawn phenomenon”
•
Source: American Diabetes Association, www.diabetes.org
HYPERGLYCEMIA
Signs and symptoms:
•
High blood glucose
•
High levels of sugar in the urine
•
Frequent urination
•
Increased thirst
•
Source: American Diabetes Association, www.diabetes.org
KETOACIDOSIS
•
“Diabetic coma”
•
Occurs if hyperglycemia goes untreated
•
Build up of ketones in the blood
•
Life-threatening
•
Call 9-1-1
•
Source: American Diabetes Association, www.diabetes.org
KETOACIDOSIS
Signs and symptoms
•
Shortness of breath
•
Breath that smells fruity
•
Nausea and vomiting
•
Very dry mouth
•
Source: American Diabetes Association, www.diabetes.org
DIGOXIN
EXAMPLES:
•
Lanoxin
DIGOXIN
HOW IT WORKS:
•
Increases the force of
the heart’s contractions
DIGOXIN
USES:
•
Heart failure
•
Arrhythmias
DIGOXIN
SIDE EFFECTS:
•
Dizziness
•
Bleeding
•
Fainting
•
•
Fast, pounding, or
irregular heartbeat or
pulse
Pinpoint red spots on
the skin
•
Rash
•
Severe stomach pain
•
Slow heartbeat
DIGOXIN TOXICITY
•
Confusion
•
Irregular pulse
•
Loss of appetite
•
Nausea, vomiting, diarrhea
•
Palpitations
•
Vision changes (unusual), including blind spots,
blurred vision, changes in how colors look, or
seeing spots)